THE EDITOR'S CORNER
There is a great deal of euphoria these days about a decline in the Consumer Price Index which orthodontists need to put in some perspective. While some economists have reservations with regard to the validity of the CPI as a measure of the inflation rate, it is the best measure that we have and it is indicating a welcome and marked decline in the inflation rate. The index rose 12.4% in 1980, 8.9% in 1981, and projections are now being made for a rate for 1982 which will be in a range of 4 to 7 percent.
In the ten years between 1970 and 1980 the Consumer Price Index rose 117%, but orthodontic fees increased only 81 %. So, orthodontists' record for keeping up with inflation has not been outstanding, and orthodontists' standard of living has yielded 36% to inflation in that ten-year period. Since just keeping up with inflation is staying even, orthodontists have not even stayed even. Some practices may have stayed even with inflation, or more than compensated for inflation, through increased numbers of case starts and/or reduced expenses. Indications are that these practices were in the minority. But, overriding the consideration of keeping up with inflation are two other crucial considerations. One is the orthodontist's perception of the value of his service. The other is the patient's perception of the value of the service.
Before an orthodontist can feel good about raising his fees, he has to feel confident that his service is worth the increase. If his only measure of the value of his service is the Consumer Price Index, it is small wonder that he might not have the necessary confidence. At one time, confidence stemmed from the fact that there were lots of patients and few orthodontists. Under those circumstances, even a low acceptance rate could not slow down income growth. A legacy of that attitude has been the one-visit case presentation, which is an idea whose time has past, assuming that it ever was a good idea.
In the one-visit case presentation, the patient is examined, a tentative diagnosis is made, the fee is quoted, and an attempt is made to gain acceptance of treatment and fee before a diagnostic workup is done. The theory behind this is that it is efficient, that people have a good idea about orthodontic treatment and only want to know what it is going to cost, that people are never readier to accept orthodontic treatment than at the first visit, that they might change their minds if given enough time to think about their decision, that they would be "turned off" by lengthy explanations, and that there is a chance that they might refuse treatment and not be willing to pay for the diagnostic workup and presentation. An orthodontist has to be lucky to get a 75% acceptance rate with such a negative approach to the start of the orthodontic relationship. Furthermore, he has created a situation in which the patient has very little more than cost to go on, with no real way of evaluating the cost.
On the other hand, an orthodontist who knows that he is going to have a 90% to 95% acceptance rate has a case presentation in which the primary concern is maximizing the patient's perception of the value of the service. This orthodontist is confident going into a case presentation, following a full diagnostic workup, totally prepared to show and explain to the patient in simple, understandable terms what the problem is and what the solution to the problem is. Now the patient makes his decision based on his knowledge of the value of the service.
Concern for the patient's perception of the value of the service is a key to gaining his confidence, but also to enhancing the confidence of the orthodontist. This cannot be done with a one-visit procedure. At a minimum, it would take a two-visit procedure, if the diagnostic records can be taken at the first visit. It might typically be a three-visit procedure. Since it is important to gain the confidence of all the decision makers, it might occasionally be a four visit procedure, in the case of divorced parents or of an apprehensive child patient. The number of visits is not important. If an orthodontist appreciates the vital part that case presentation plays in establishing the orthodontic relationship, he will have the time and personnel to perform this step properly.
Since value is something that must be delivered to be appreciated, rather than described or anticipated, the confidence of the patient and the orthodontist are enhanced by periodic progress evaluation and reports, and by post-treatment evaluation and presentation of the results of treatment. For the orthodontist to have the confidence that his service is worth his fee, he needs this systematic evaluation of the quality of the service. When the confirming evaluations are made to the patient, the patient's confidence is reinforced that he made a correct decision in the first place, and he feels impelled to recommend others to the practice.
Another contributor to the orthodontist's perception of the value of his own service is the extent to which he is certain that the service is better every year, not alone because of his added experience, but because of the effort, time, and money that he invests every year to improve the service and broaden the service through study of his own cases, and through reading and attendance at meetings and courses. The orthodontist who continues his education in these ways in areas such as orthodontic diagnosis and treatment planning, technique, occlusion, TMJ, and management - in addition to exploring the leading edge of new developments can feel confident that he is trying harder to deliver a service for his patients that can be better than his neighbor who may not be doing those things.
Of course, the public's resistance to an orthodontist's fees can be a great deterrent to an orthodontist's confidence, but he should not accept that unless and until he has done everything he should to maximize the value of his service and the perception of the value of his service by himself and by his patients and prospective patients.
